MILIARY TUBERCULOSIS. 251 



these nodules, yet it is very rare that any condition 

 other than that due to the fusion together of several of 

 these minute foci can be detected by the naked eye. 



The miliary tubercles are of a pale gray color, with a 

 white centre, are slightly elevated above the surface of 

 the tissue in which they exist, and, as stated, vary con- 

 siderably in dimensions, usually appearing as points 

 which range in size from that of a pin-point to that of a 

 pin-head. They are not only located upon the surface of 

 the organs, but are distributed through the depths of 

 the tissues. To the touch they sometimes present nothing 

 characteristic, but may frequently, when closely packed 

 together in large numbers, give a mealy or sandy sensa- 

 tion to the fingers. Stained sections of these miliary 

 tubercles present an entirely characteristic appearance, 

 and the disease may be diagnosticated by these histologi- 

 cal changes alone, though the crucial test in the diagnosis 

 is the finding of tubercle bacilli in these nodules. 



MicEOSCopic Appeaeance of Miliaey Tiibee- 

 CLES. — The simple miliary tubercles under the low mag- 

 nifying powerof the microscope present somewhat the fol- 

 lowing appearance : There is a central pale area, evidently 

 composed of necrotic tissue because of its incapacity for 

 taking up the nuclear stains commonly employed. 

 Scattered here and there through this necrotic area may 

 be seen granular masses irregular in size and shape ; 

 they take up the stains employed and are evidently the 

 fragments of cell-nuclei in the course of destruction. 

 Through the necrotic area may here and there be seen 

 irregular lines, bands, or ridges, the remains of tissues 

 not yet completely destroyed by the necrotic process. 

 Around the periphery of this area may sometimes be 

 noticed large multi-nucleated cells, the nuclei of which 



